Tuberculosis (TB) has now overtaken HIV as the world’s leading cause of mortality. There were about 10.4 million TB cases in 2016, despite the fact that TB is an old and often curable disease whose incidence declined in industrialized countries long before the introduction of the TB vaccine and anti-TB drugs. TB continues to disproportionately affect low-income countries. For those of us who work in public health, this is tragic — we ought to be moving forward at a much faster pace to end TB for good.
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A version of this post originally appeared on FHI 360’s R&E Search for Evidence blog.
Tuberculosis (TB), which in 2016 killed an estimated 1.7 million people, is an ancient disease found in the bones of mummies dug up from Peru. It has evolved with humans, and like other successful organisms, finds ways to avoid death, so it can thrive and spread to the next person. Trying to get ahead of this successful adversary requires pursuing a consistent, aggressive research agenda aided by international collaboration.
The global health community is concerned that tuberculosis (TB) continues to disproportionately kill people living with HIV, despite the availability of TB preventive therapy. According to the World Health Organization’s Global Tuberculosis Report 2019, deaths attributed to TB among people living with HIV account for 17 percent of all TB deaths, even though people living with HIV account for only 8.6 percent of overall TB cases.
Since the early stages of the COVID-19 pandemic, many countries have reported alarming rates of violence, exploitation and other abuse, especially intimate partner violence among women and other marginalized groups. UN Women has warned that, as countries continue lockdowns and sheltering-at-home measures, a shadow pandemic of violence is growing. More than ever, the United Nation’s 16 Days of Activism against Gender-Based Violence is an important opportunity for international development organizations to commit to identifying ways to prevent and respond to violence, exploitation and other abuse in the communities where humanitarian and development projects are being implemented.
Since the term “impact investing” took hold more than a decade ago, we’ve known that making investments that create positive social or environmental impact and generate a financial return would require engagement from both the social and private sectors. However, it wasn’t until 2016 that the extent of the work of international nonprofits in impact investing was revealed, when members of the International Non-Governmental Organization (INGO) Impact Investing Network released their inaugural piece of thought leadership: Amplifyii:The INGO Value Proposition for Impact Investing. That report, featured in the NextBillion post Philanthropy is Changing Fast: 12 Lessons from Three Reports, was the first real landscape report charting the work of INGOs in impact investing. Two years later, the network came back together to release the next chapter of the story of INGOs in impact investing: Amplifyii: The Next Mile of Impact Investing for INGOs.
World AIDS Day 2015 comes at a watershed moment in the fight for the health of people living with HIV and for the health of all the citizens of this planet. The two are intimately related: HIV has, for the last three decades, defined the landscape of ambitious, collaborative and innovative responses that marry science, rights, community-based responses and structural change. Ultimately, these responses can be leveraged to improve health everywhere, but only if we continue to make real progress in battling HIV.
In recent years, collaborations between research teams and thousands of volunteers in clinical trials have yielded insights into how to use HIV prevention and treatment options to end the epidemic. These insights have led to the Joint United Nations Programme on HIV/AIDS (UNAIDS) “Fast-Track” approach to ending the epidemic, which sets ambitious targets for a range of interventions, including 27 million voluntary medical male circumcisions by year 2020, three million people on daily oral pre-exposure prophylaxis (PrEP) annually, major reductions in violence against women, improvements of human rights and, of course, the 90-90-90 targets for 2020: 90 percent of all people living with HIV will know their HIV status, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART) and 90 percent of all people receiving ART will have viral suppression.
The world has gotten this far because of massive investments in the HIV response. To actually end the epidemic, though, it is imperative that we resist complacency, cutbacks in funding and a sense that, on any level, our work is done.
Over the last 15 years, the Millennium Development Goals guided the global response to development. Health, including controlling HIV, figured prominently in these goals. In September, the members of the United Nations adopted the Sustainable Development Goals (SDGs), which will guide policy and funding for ending poverty everywhere over the next 15 years. Health is one of 17 goals. To meet it, funders, implementers and country governments will need to be smarter with investments in HIV/AIDS. This means working side by side with people living with and most affected by HIV to develop rights-based approaches and efficient and community-supported service delivery models. And, it means thinking beyond any single health issue and toward integrated approaches that both fight HIV and contribute to ending poverty, hunger and inequality.
This year began on an optimistic note for scientists, policy makers and those most affected by tuberculosis, with the licensing of a drug that represents the first new approach to treating the disease in more than 40 years. This year’s World TB Day gives us an opportunity to reflect on the progress we have made in confronting this ancient but persistent disease, as well as the challenges that remain. This year, with budget issues threatening the immediate future of medical research, the approval of a new tuberculosis treatment sheds light on the path ahead.
The newly licensed drug, known as bedaquiline or Sirturo, is important because it has shown promising results against tuberculosis that has become resistant to other treatment – often called multidrug-resistant (MDR) tuberculosis. I served on the [U.S. Food and Drug Administration] FDA advisory panel that recommended approval of the drug and I was happy that the agency concurred. However, we need not just one, but several new drugs to put together in successful combination if we are to avoid the mistakes of the past and avoid a future where tuberculosis is again a highly fatal, untreatable disease. Now is the time to put our foot on the accelerator, not the brakes.
In the middle of the last century, tuberculosis was considered conquered. Today, it is the world’s second leading infectious disease killer, taking nearly 2 million lives each year. Furthermore, a frightening proportion of new cases of tuberculosis in China, Eastern Europe, India, Russia and South Africa are resistant to current first-line drugs. With air travel, cross-cultural exchanges and immigration, patterns of resistance are steadily making inroads in the United States as well. HIV has fueled tuberculosis across Africa, Asia and Eastern Europe, while the drugs and diagnostics have become increasingly outdated. The disease, in short, has evolved faster than the tools developed in the last century to fight it. Now, it is estimated that more than 1,000 people infected with HIV die every day from tuberculosis, a curable disease.